Commentary — April 11, 2012, 12:51 pm

A New Front in the War Against Malaria

Matthew Power is a contributing editor of Harper’s Magazine. His article “Slipping Through the Net: Cambodia’s border war against drug-resistant malaria” appears in the April 2012 issue.

aaronhueynets600

Photograph by Aaron Huey

In October 2007, Bill and Melinda Gates—benefactors of the largest private foundation in the world—stood before a packed audience of public-health experts and government officials in Seattle and announced their intention to free the world of malaria, a disease that has haunted all of human history. It was an audacious objective—one that met with public praise and private skepticism from malariologists who had spent their careers in an often-losing battle.

The Gateses—and $1.75 billion of their money—have been at the vanguard of a newly energized campaign against the mosquito-borne parasites that cause malaria. Remarkable progress has been made in the past decade: in 2000, the World Health Organization estimated that 3,000 people were dying daily from the disease; today, that number is down to 2,000. One of the key pillars of the fight is a multidrug treatment that includes artemisinin, a potent antimalarial derived from sweet wormwood. As such older malaria drugs as chloroquine and pyremethamine have gradually lost their efficacy, malaria-control programs around the world have rolled out an artemisinin-based combination therapy as the frontline treatment. Hailed initially as a magic bullet, the drug has by some estimates saved more than a million people—most of them children in sub-Saharan Africa. Currently, no other drugs exist to replace artemisinin in the public-health arsenal.

As I reported in the April issue of Harper’s Magazine, in 2008 researchers announced that artemisinin resistance was beginning to appear among malaria patients in a remote area of western Cambodia, along the border with Thailand. The possible causes were manifold: the spread of counterfeit antimalarials, inadequate dosages for genuine ones, and a highly mobile and inaccessible population. Fearing disastrous consequences, the Gates Foundation disbursed $22 million for an ambitious program, spearheaded by the WHO, to try and contain the spread of artemisinin resistance.

Now, three years after that containment effort began, and just as some signs of success have been reported, a new study has been published showing that the problem may be far more widespread than previously suspected. The article, published this month in The Lancet, examines the malaria-parasite clearance rates of 3,202 patients treated with artemisinin from 2001 to 2010 along the border of Thailand and Burma, hundreds of miles from the Thai–Cambodian border region where resistance was first observed. While the drug was still able to halt malaria, researchers noted a disturbing trend: cases with a slow clearance rate (a sign that drug efficacy is weakening) increased from 0.6 percent in 2001 to 20 percent in 2010. In other words, drug-resistant malaria had already begun to spread out of the containment zone before researchers were aware of its existence. In as few as two years, the researchers found, resistance rates along the Thailand–Burma border could be as high as the ones Gates and the WHO have spent millions trying to contain in Cambodia. The fate of artemisinin—and the global fight against malaria along with it—is now more tenuous than ever, and the net to contain resistance must be cast farther afield.

These new findings are especially unwelcome because of their location. Cambodia, for all its structural and economic problems (partly a legacy of its civil war), has a very engaged and committed public-health sector, aided by the presence of numerous NGOs. Burma, by contrast, has a poorly funded public-health infrastructure and hosts far fewer international health monitors, an unfortunate consequence of its ostracism by foreign governments during decades of military rule. It also has by far the highest disease burden in Southeast Asia, with nearly half a million malaria cases annually. Furthermore, Burma borders India, which has 1.6 million cases annually; from there, researchers fear, a domino effect of drug-resistance could begin, ultimately reaching the vast parasite pool of Africa, where 90 percent of the world’s malaria cases occur.

The recent parliamentary byelections in Burma, and particularly the landslide victory of former political prisoner Aung San Suu Kyi, have inspired hope for political change there for the first time in decades. The country faces an epic challenge in rebuilding its civil-society institutions, and it is still early to celebrate the junta’s obsolescence. Malaria is not likely atop the priority list. Burma didn’t ask to find itself on the front line of the war against malaria, but if artemisinin and the global health infrastructure that depends on it are to be saved, that is where the fight must now turn.

Share
Single Page
undefined

More from Matthew Power:

From the April 2012 issue

Slipping through the net

Cambodia’s border war against drug-resistant malaria

From the March 2008 issue

Mississippi Drift

River vagrants in the age of Wal-Mart

Get access to 169 years of
Harper’s for only $23.99

United States Canada

CATEGORIES

THE CURRENT ISSUE

July 2019

Ramblin’ Man

= Subscribers only.
Sign in here.
Subscribe here.

“Just Keep Going North”

= Subscribers only.
Sign in here.
Subscribe here.

El Corralón

= Subscribers only.
Sign in here.
Subscribe here.

Marmalade Sky

= Subscribers only.
Sign in here.
Subscribe here.

New Books

= Subscribers only.
Sign in here.
Subscribe here.

The Trials of Vasily Grossman

= Subscribers only.
Sign in here.
Subscribe here.

view Table Content

FEATURED ON HARPERS.ORG

Article
“Just Keep Going North”·

= Subscribers only.
Sign in here.
Subscribe here.

On February 5, 2019, the president of the United States (a certain Donald Trump) in his State of the Union speech warned of “migrant caravans and accused Mexican cities of busing migrants to the border ‘to bring them up to our country in areas where there is little border protection.’ ”? Wishing to see the border for myself, I decided to visit Arizona, where my ignorance of local conditions might save me from prejudgment.

Post
English Referendums and Scotch Voters·

= Subscribers only.
Sign in here.
Subscribe here.

After years of post-Brexit uncertainty, Scotland’s independence movement has become resurgent

Article
No Joe!·

= Subscribers only.
Sign in here.
Subscribe here.

In the heart of the US Capitol there’s a small men’s room with an uplifting Franklin Delano Roo­sevelt quotation above the door. Making use of the facilities there after lunch in the nearby House dining room about a year ago, I found myself standing next to Trent Lott. Once a mighty power in the building as Senate Republican leader, he had been forced to resign his post following some imprudently affectionate references to his fellow Republican senator, arch-segregationist Strom Thurmond. Now he was visiting the Capitol as a lucratively employed lobbyist.

Article
Marmalade Sky·

= Subscribers only.
Sign in here.
Subscribe here.

On a November Saturday in 1990, Pam went over to Joe’s place to listen to records. It was raining in sheets that whipped around the corners of buildings and blowing so hard that women in heels were taking men’s arms to cross the street. Cars were plowing bow waves through puddles of scum.

As Joe was letting Pam into the apartment, a man emerged from the bedroom with a square sheet of black plastic in his hand and said, “Hey, man, you have the Sassy Sonic Youth flexi!”

Article
New Books·

= Subscribers only.
Sign in here.
Subscribe here.

Discussed in this essay:

Semicolon: The Past, Present, and Future of a Misunderstood Mark, by Cecelia Watson. Ecco. 224 pages. $19.99.

Four Men Shaking: Searching for Sanity with Samuel Beckett, Norman Mailer, and My Perfect Zen Teacher, by Lawrence Shainberg. Shambhala. 144 pages. $16.95.

Japanese Tales of Lafcadio Hearn, edited by Andrei Codrescu. Princeton University Press. 224 pages. $22.95.

Cost of renting a giant panda from the Chinese government, per day:

$1,500

A recent earthquake in Chile was found to have shifted the city of Concepción ten feet to the west, shortened Earth’s days by 1.26 microseconds, and shifted the planet’s axis by nearly three inches.

Boaty McBoatface, an autonomous underwater vehicle that was named in a 2016 internet poll, discovered that stronger Antarctic winds, the result of a growing hole in the ozone layer, have been causing more ocean turbulence, which in turn has raised sea levels and temperatures.

Subscribe to the Weekly Review newsletter. Don’t worry, we won’t sell your email address!

HARPER’S FINEST

Happiness Is a Worn Gun

By

“Nowadays, most states let just about anybody who wants a concealed-handgun permit have one; in seventeen states, you don’t even have to be a resident. Nobody knows exactly how many Americans carry guns, because not all states release their numbers, and even if they did, not all permit holders carry all the time. But it’s safe to assume that as many as 6 million Americans are walking around with firearms under their clothes.”

Subscribe Today